Chiropractic care for neck pain
A neck that stiffens through the working day is usually carrying a load rather than an injury, and working out what is loaded is what the first visit is for.
Sound familiar?
- “it seizes up by the afternoon”
- “I cannot turn my head to reverse”
- “tech neck”
What it actually is
An adult head weighs about five kilograms, and for most of a working day the neck holds it still rather than moves it. Balanced over the shoulders, the bones carry that weight. Carried forward towards a screen, the muscles at the back of the neck and between the shoulder blades take it instead, and hold it there for as long as you sit.
Which is why a neck that stiffens through a working day usually cannot be traced to one wrong movement. Muscles were asked to hold a weight in one position for hours while the joints under them moved through a fraction of their range. There is no single position that is the bad one and none that is the safe one: joints do well on movement, muscles complain when they are held, and two hours without shifting will make almost any position uncomfortable, including a textbook-perfect one.
The shape a laptop pulls you into gets called “tech neck”: head forward, chin poking, shoulders rounded. It names where the strain is going. It is not a disease, not permanent damage, and no photograph of how somebody sits is a prognosis.
What usually happens from there follows the load rather than anything structural. The day-to-day shape is a familiar one: it builds through the afternoon and peaks on the walk home. When the loading changes, the soreness generally changes with it, and a heavy desk week bringing the same ache back is that pattern repeating rather than permanent damage.
Higher up, the pain does not always stay in the neck. Nerves from the top three levels meet the nerve that supplies the face and scalp at a shared junction in the brainstem, so the brain can read an irritated joint down there as an ache behind one eye or a band across the head. A neck problem can arrive looking like a headache: can a headache really start in your neck?
What people notice
- stiffness that builds through the working day
- less turn to one side, so reversing means turning your shoulders
- an ache across the tops of the shoulders and between the shoulder blades
- tenderness at the base of the skull
- waking sore after a night in an awkward position
- a headache that turns up with the stiffness rather than alone
Where it sits in the body
- the top three levels of the neck, under the base of the skull
- the smaller joints below them, which glide as you turn and bend
- the deep muscles at the front of the neck that support and steady the head
- the muscles along the back of the neck and shoulder blades
- the nerve roots leaving the neck for the shoulder and arm
- the brainstem junction where neck and face nerves meet
What the assessment looks for
The assessment works out what is actually loaded, because a neck refers pain around and the sorest spot is not always the source. It starts with your story, and the useful questions are specific: which way you have stopped turning, whether the first hour of the morning is the worst of it or the last hour of the day, whether a pillow changed anything, and whether anything at all travels past your shoulder. Then it is tested.
- how far the neck turns, bends and extends, and which movement reproduces your pain
- whether pressure on the joints at the top of the neck brings on the headache you recognise
- how the deep muscles at the front of the neck hold up when they are asked to work
- the nerves into the shoulder and arm: strength, reflexes and sensation
- the screen, the phone, the pillow and the chair, because the hours between visits do most of the loading
Imaging is not part of a routine neck assessment. A scan shows structure well and says nothing about how you move, and findings in the upper part of the neck are common on the scans of people who have no headache at all, which is why the international headache classification treats them as suggestive rather than firm evidence of a cause. It is suggested when clinically indicated, meaning when something in your history or your examination would change what happens next. That question has an article of its own: do I need an X-ray or scan before seeing a chiropractor?
Choosing between professions? Should I see a chiropractor, a physio or an osteopath? compares the three for a sore neck.
What care involves
Two things run at once. The joints that have stopped turning get worked on directly, along with the muscles that have been taking the weight of the head, and the hours between visits, which is where the load actually comes from, get changed. The hands-on half is gentle joint mobilisation, which is slow rhythmic movement with no thrust and no click, soft-tissue work through the muscles that have been holding on, and instrument adjusting or drop-piece techniques where they suit better.
A neck adjustment is one option among those, not a requirement, and it is never automatic. You hear what is being suggested and why before it happens, and you can decline any part of it without it being awkward.
The other half is yours: strength through the neck and upper back, the screen at about eye height, the phone lifted rather than the head dropped, and a reason to stand up and turn your head both ways. Both halves run together, and the care here is built for lasting improvement rather than short-term relief. The long version of that half is why does my neck hurt after a day at my desk?
How often to come in, and how that gets decided with you, is set out in how many visits will I need?
Everyone moves through this differently, so the plan is paced to your body, reviewed with you as you progress, not read off a fixed schedule of visits.
What the guidelines say
- International Headache Society, The International Classification of Headache Disorders, 3rd edition, 11.2.1 Cervicogenic headache, 2018. https://ichd-3.org/11-headache-or-facial-pain-attributed-to-disorder-of-the-cranium-neck-eyes-ears-nose-sinuses-teeth-mouth-or-other-facial-or-cervical-structure/11-2-headache-attributed-to-disorder-of-the-neck/11-2-1-cervicogenic-headache/
When to get it looked at
Some things are checked before anybody works on a neck, and screening for them comes first.
Call an ambulance if there is any confusion, sudden weakness or numbness in the face, arm or leg on one side, facial drooping, slurred speech, sudden trouble speaking, seeing or understanding, loss of vision, a seizure, or a sudden loss of balance or coordination. Call an ambulance or go to a hospital emergency department straight away if a headache comes on suddenly and severely (the worst you have ever had), if a headache arrives with fever, a stiff neck or a rash, or if a headache follows a knock to the head. Go to a hospital emergency department straight away for back or neck pain after a serious fall or a high-impact accident, such as a car accident; back or neck pain with a fever or feeling generally unwell; or new back or neck pain if your immune system is weakened, for instance by long-term steroids or chemotherapy, if you inject drugs, or if you have recently had a spinal injection, spinal surgery or a dental procedure.
Go to a hospital emergency department straight away if you have weakness in one arm that is severe or getting worse, or numbness in an arm that is spreading or getting worse quickly. Go to a hospital emergency department the same day if you have new clumsiness in both hands, or new unsteadiness on your feet. Go to a hospital emergency department straight away if you have numbness or altered feeling around the saddle area, meaning the groin, the inner thighs, the buttocks or the genitals; a loss of normal sensation in the genitals, including during sex; trouble starting to pass urine, or any new change in your bladder or bowel control; weakness in both legs, particularly if it is getting worse; new or worsening pain running down both legs; weakness in one leg that is severe or getting worse, or a foot that has started to catch or drag when you walk; or numbness in a leg that is spreading or getting worse quickly.
See your GP promptly, before booking here, if you have pins and needles, numbness or weakness in an arm or hand, a history of cancer, unexplained weight loss, pain at night that will not settle in any position, or known osteoporosis with new severe pain. See your GP first if you have a brand-new type of headache, if your usual headache has changed its pattern, if your first bad headaches have started after the age of 50, if they are worse lying down or when you cough or strain, if you are taking pain relief for headaches more than a couple of days most weeks, or if you think you may have migraine and have never been assessed.
What is worth booking on is simpler: a neck that has stopped getting better on its own. It is not easing, the same pain keeps coming back, or it is now bringing headaches with it.
Common questions
I do not want my neck cracked. Is there still something here for me?
Yes. Say so at the start and it is written down rather than asked about again. Most of a neck assessment is movement being tested, and the hands-on work that follows can stay with slow mobilisation, soft tissue and exercise. Nothing happens to your neck that you have not heard explained and agreed to first.
Do I need a scan of my neck before I come in?
No, and nothing about booking depends on having one. The thing worth knowing is that a report describing wear and tear does not explain a sore neck on its own, which is why the examination comes first either way. If you already have imaging, bring the images as well as the report.
The headache and the stiff neck turn up together. Which one is the problem?
The order they arrived in tells us less than the examination does. What tells us most is whether testing your neck reproduces the headache you already recognise, though that points towards an answer rather than settling it on its own. If it does not, we say so on the day instead of working on the neck anyway. Where a headache needs a diagnosis and medication, that part belongs with your GP and the neck work runs alongside it.
What if the pain runs down into my arm?
Arm symptoms change what happens first. Call an ambulance if arm, jaw or neck pain comes with chest pain, pressure or tightness, shortness of breath, sweating, nausea or dizziness. Go to a hospital emergency department straight away if you have weakness in one arm that is severe or getting worse, or numbness in an arm that is spreading or getting worse quickly. See your GP promptly, before booking here, if you have pins and needles, numbness or weakness in an arm or hand, a history of cancer, unexplained weight loss, pain at night that will not settle in any position, or known osteoporosis with new severe pain. If none of those apply, tell us about the arm when you book, because it changes what gets tested. Pain that runs from the neck into the arm and fingers can mean a nerve root leaving the neck has been irritated, and the arm then gets its own examination: strength, reflexes and sensation, as well as the neck itself.
The nervousness behind the first of those questions is common enough to have an article of its own. Is chiropractic safe, and what does the evidence actually say? goes through what the risks of neck work are, and what the published guidelines do and do not say, without talking around either.
Read next
Nearby: Chiropractic care for headaches that start in the neck and Chiropractic care for posture.
The clinic is at Suite 1, Lower Ground Floor, 225 Macquarie Street, Sydney NSW 2000. How to find us, or read all the conditions we see.
Take the first step towards better movement.
Suite 1, Lower Ground Floor, 225 Macquarie Street, Sydney NSW 2000. No referral needed to book.